Feds say 'passive surveillance' enough for now

Swine flu expected to continue spreading

Homeland Security Secretary Janet Napolitano

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Governor signs flu vaccine act

ATLANTA - Governor Sonny Perdue today signed House Bill 217, the "Access to Flu Vaccines Act," which permits pharmacists and nurses to order and dispense flu shots pursuant to a protocol agreement with a physician. The bill also grants the Governor broader emergency powers if a pandemic influenza is declared by the World Health Organization or the Centers for Disease Control.

"The flu affects thousands of people each year and our citizens should be able to access flu vaccines to protect themselves and their families," said Governor Perdue. "This legislation makes it easier for Georgians to receive flu shots and allows the state to respond quickly and effectively to any flu outbreak."

The bill was introduced in January by State Rep. Jimmy Pruett, one of the Governor's floor leaders in the House. The bill was intended to clarify the ability of pharmacists and nurses to dispense flu shots without individual prescriptions. Last fall, the Composite Board of Medical Examiners, in consultation with the Attorney General's office, determined the flu shot to be a "dangerous drug" and therefore each person seeking a vaccination would need an individual prescription.

The "Access to Flu Vaccines Act" returns the state to the past practices of more than a decade, allowing physicians to enter into protocol agreements with pharmacists and registered nurses to allow the ordering and dispensing of flu shots without a physician's individual prescription. To ensure quality control, physicians may issue no more than 10 standing orders with pharmacists and nurses within the same county or adjacent county to the physician's primary place of business. Corporations with more than one location are also included in this agreement. This includes grocery stores and drug stores.

HB 217 ensures hospitals have the explicit authority to offer its staff or patient any vaccination, test or prophylactic matter required or recommended by the CDC.

The bill also includes an emergency powers provision that allows the Governor to declare a "pandemic influenza" state of emergency if the WHO declares a Phase 5 Pandemic Alert for influenza in the United States and/or Georgia or the CDC declares at least a Category 2 Pandemic Severity index for influenza in the United States or Georgia.

Homeland Security Secretary Janet Napolitano declared that more draconian enforcement steps are not yet necessary, even as she acknowledged that officials "anticipate confirmed cases in more states." She reiterated President Barack Obama's stance that people are justifiably concerned but need not be alarmed by it.

Some 50 swine flu infections have been identified so far in the United States, but no deaths. In contrast, there have been over 150 deaths in neighboring Mexico, and Asian countries deployed thermal sensors at airports to screen passengers from North America for signs of fever.

Napolitano assured network interviewers of a "very broad multi-agency federal response" and said that she and a number of Cabinet members had met into the night Monday to discuss strategy. She also the administration wouldn't wait for a World Health Organization declaration of a pandemic to deliver a pandemic-like response.

Noting that the international health body has elevated its pandemic alert status to Level 4 of a 6-step process, Napolitano said: "We're prepared as if there were a pandemic. We're not waiting."

Obama on Monday responded to the first domestic emergency of his presidency by urging calm - and then dispatching officials to the cameras to again back up that message. He said the flu outbreak was "not a cause for alarm," even as the government began urgent steps to respond to the small but rising number of cases. The calming words belied an intense reaction across departments and agencies.

Richard Besser, the acting director of the Centers for Disease Control and Prevention, said his agency was aggressively investigating, looking for evidence of the disease spreading and probing for ways to control and prevent it.

The government also issued an advisory warning travelers to cancel any nonessential visits to Mexico - and gently took issue with a European Union health official who said the same thing about travel to parts of the U.S.

At the White House, a swine flu update, delivered by White House homeland security adviser John Brennan, was added to the president's daily intelligence briefing. And on Capitol Hill, several panels scheduled emergency hearings for this week.

On Tuesday, Napolitano said that federal efforts to get antiviral medications to the states "is under way and is working."

The Food and Drug Administration, for instance, issued emergency guidance late Monday that allows certain antiviral drugs to be used in a broader range of the population in case mass dosing is needed to deal with a widespread swine flu outbreak.

The agency originally approved the use of the antiviral drug Tamiflu for the prevention and treatment of influenza in adults and children age 1 and older. Another antiviral drug, Relenza, was originally approved to treat people 7 and older and to help prevent flu in those 5 and older.

Napolitano was asked point-blank in one interview if the monitoring that the U.S. is now conducting at entry points in the country is sufficient. "We think that what we're doing now at the land ports and the airports makes sense," she replied.

Asked whether tougher steps were under consideration, she said: "That's something that can be considered, but you have to look at what the costs are. We literally have thousands of trucks and commerce that cross that border ... That would be a very, very heavy cost for what epidemiologists tells us would be marginal" in terms of containing the virus.

The White House also aimed to sidestep a potentially problematic diplomatic headache. Press secretary Robert Gibbs declined to discuss whether Obama officials have any concern about when Mexico notified the U.S. of the outbreak - particularly significant given the president's trip to Mexico on April 16 and 17.

The White House said Monday that its medical unit asked if Mexican health officials and U.S. Embassy medical staff had any concerns about infectious disease and were told they did not. But a White House statement said, "We have no reason to believe they withheld any information they had at the time."

The first case of swine flu was reported in Mexico three days before Obama's arrival. Gibbs said the White House was not told, but he stressed that the president's doctors have no concern about his health.